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Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study

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An Erratum to this article was published on 05 February 2008

Abstract

Objective

To evaluate physicians' reasoning, considerations and possible difficulties in end-of-life decision-making for patients in European intensive care units (ICUs).

Design

A prospective observational study.

Setting

Thirty-seven ICUs in 17 European countries.

Patients and participants

A total of 3,086 patients for whom an end-of-life decision was taken between January 1999 and June 2000. The dataset excludes patients who died after attempts at cardiopulmonary resuscitation and brain-dead patients.

Measurements and results

Physicians indicated which of a pre-determined set of reasons for, considerations in, and difficulties with end-of-life decision-making was germane in each case as it arose. Overall, 2,134 (69%) of the decisions were documented in the medical record, with inter-regional differences in documentation practice. Primary reasons given by physicians for the decision mostly concerned the patient's medical condition (79%), especially unresponsive to therapy (46%), while chronic disease (12%), quality of life (4%), age (2%) and patient or family request (2%) were infrequent. Good medical practice (66%) and best interests (29%) were the commonest primary considerations reported, while resource allocation issues such as cost effectiveness (1%) and need for an ICU bed (0%) were uncommon. Living wills were considered in only 1% of cases. Physicians in central Europe reported no significant difficulty in 81% of cases, while in northern and southern regions there was no difficulty in 92–93% of cases.

Conclusions

European ICU physicians do not experience difficulties with end-of-life decisions in most cases. Allocation of limited resources is a minor consideration and autonomous choices by patient or family remain unusual. Inter-regional differences were found.

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Acknowledgements

This study was funded by the European Concerted Action Project and by the European Commission (Contract PL 963733), the Chief Scientists' Office of the Ministry of Health, Israel (grant 4226), and the OFES Switzerland/Biomed (grant 980271). The study also received funding from the European Society of Intensive Care Medicine and the Walter F and Alice Gorham Foundation Inc.

Author information

Authors and Affiliations

  1. General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, , Israel

    Charles L. Sprung

  2. Critical Care Directorate, Southampton University Hospitals NHS Trust, Southampton, UK

    Thomas Woodcock

  3. Department of Anesthesiology, Orebro and Huddinge University Hospital, Stockholm, Sweden

    Peter Sjokvist

  4. Department of Anesthesiology, Hopital Cantonal Universitaire de Geneve, Geneva, Switzerland

    Bara Ricou

  5. Department of Anesthesiology, University Hospital of Glostrup, Glostrup, Denmark

    Hans-Henrik Bulow

  6. Department of Anesthesiology, Herlev University Hospital, Herlev, Denmark

    Anne Lippert

  7. Department of Intensive Care, Hospital Geral Santo Antonio, Porto, Portugal

    Paulo Maia

  8. Department of Medicine, University College of London, London, UK

    Simon Cohen

  9. The Hebrew University – Hadassah School of Public Health, Hadassah Hebrew University Medical Center, Jerusalem, Israel

    Mario Baras

  10. Department of Anesthesiology, South Karelia Central Hospital, Lappeenranta, Finland

    Seppo Hovilehto

  11. Department of Anesthesiology and Intensive Care Medicine, University of Liege, Liege, Belgium

    Didier Ledoux

  12. Department of Intensive Care, Mater Hospital, University College, Dublin, Ireland

    Dermot Phelan

  13. Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden

    Elisabet Wennberg

  14. Division for General and Surgical Intensive Care Medicine, University Hospital Innsbruck, Innsbruck, Austria

    Wolfgang Schobersberger

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  1. Charles L. Sprung
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Corresponding author

Correspondence to Charles L. Sprung.

Additional information

For the ETHICUS Study Group

P. Sjokvist died during the preparation of this manuscript.

An erratum to this article can be found at http://dx.doi.org/10.1007/s00134-007-0949-8

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Sprung, C.L., Woodcock, T., Sjokvist, P. et al. Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study. Intensive Care Med 34, 271–277 (2008). https://doi.org/10.1007/s00134-007-0927-1

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  • DOI: https://doi.org/10.1007/s00134-007-0927-1

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